Faculty Bibliography

That chilling forecast is based in part on the organization's analyses showing that on average, a patient infected with drug-resistant tuberculosis in 2004 was resistant to more drugs than a similar patient with that diagnosis in 1994, Dr. Paul P. Nunn, a TB expert for the organization, said at a news conference. Health officials say that Mr. Speaker's was not an isolated case because the extremely resistant form has been reported in 37 countries. With the growth of international travel, health officials say that TB anywhere is TB everywhere. About 420,000, or 5 percent, of the estimated 8.8 million new cases of tuberculosis in the world are now resistant to many standard antituberculosis drugs, Dr. Mario C. Raviglione, who directs the W.H.O.'s tuberculosis department, said in an interview. About 30,000 of the 420,000 cases are extremely drug-resistant, meaning they are resistant to first-line and a number of second-line drugs. Dr. Raviglione said the organization had begun to undertake statistical modeling studies to estimate how prevalent drug-resistant tuberculosis might become. Outcomes from such studies depend on a number of variables and none have been published. ''It is possible that in some settings drug-resistant tuberculosis could completely replace standard tuberculosis,'' Dr. Raviglione said

Yesterday Dr. [Robert Cooksey] did not directly address the question of what he would have done under the same circumstances. ''I wasn't in that situation,'' Dr. Cooksey said on the ABC program ''Good Morning America,'' ''but I probably would have done the very same thing.'' The Fulton County health officials said they ''preferred'' that Andrew Speaker not travel but did not cite a specific reason. Ted Speaker said that he asked a health official whether he was ''just saying this to cover yourself'' and that the official replied, ''Yes.'' Dr. [Julie L. Gerberding] also said that at several times ''he helped us facilitate communication with his son-in-law and the wife,'' Sarah. Dr. Cooksey's ''assistance was actually extremely helpful in getting us in cellphone'' contact with Andrew Speaker in Europe, Dr. Gerberding said, ''to help us determine how to help him get into a safer health care environment.''

Russ Knocke, chief press secretary for the Homeland Security Department, would not confirm the agent's rationale for releasing the man, saying only that the case was under investigation by its internal affairs and inspector general's offices. And in yet another twist to the story that seems to grow murkier with each new revelation, Speaker's father-in-law, Robert Cooksey, is a tuberculosis researcher who has worked at the Centers for Disease Control. Also, Italian officials said that they had not learned about the case until Speaker left Italy. Cesare Fassari, a spokesman for Italy's Health Ministry, said that had the Italian health officials been notified in time, they would have 'intercepted the man and invited him to be treated in a hospital' with his permission

When asked why the health organization could not move more quickly and catch up with Mr. Speaker before he took more flights, Dr. [Julie L. Gerberding] said in the press conference that much of the previous week's activity had been spent debating issues concerning the laws and regulations that govern isolation and quarantine in the United States and internationally. The World Health Organization regulations, she said, are ''wonderful statements of principles'' that do not provide ''operational details of things like who should pay to move a patient, or who should care for a patient.'' She said, ''I think a central question that we will be grappling with is, whose patient is it?'' Though their accounts differ, the county health authorities and Mr. Speaker agree that the officials did not try to forcibly restrict Mr. Speaker's movement. Dr. [Steven R. Katkowsky], the county official, said that the law presented ''kind of a Catch-22'' when it comes to restricting the activities of tuberculosis patients against their will. ''A patient has to be noncompliant before you can intervene,'' he said. ''There's no precedent for a court stepping in before a patient has proven himself to be non-compliant.'' It would have been an extraordinary step that, while not unheard of in tuberculosis cases, would evoke a centuries-old struggle to balance public health and individual liberty. The term ''quarantine'' comes from the Italian phrase ''quaranta giorni,'' or ''40 days,'' the amount of time Venetians isolated those coming into port in the plague years of the 14th century, said Robert Klitzman, a co-founder of the Columbia University Center for Bioethics and an associate professor of clinical psychiatry at the university's College of Physicians and Surgeons

The CDC confirmed that the strain of tuberculosis that Speaker has does not match any of the strains in its laboratories. And [Robert Cooksey] said, 'My son-in-law's TB did not originate from myself or the CDC's labs, which operate under the highest levels of biosecurity.' Although health officials said there was a low risk of Speaker transmitting tuberculosis to his fellow passengers, the case raised troubling new questions about the nation's ability to defend its borders against the entry of dangerous infectious diseases and about CDC's ability to handle such threats. Dr. Gwen A. Huitt, an infectious disease expert at the center, said her initial impression was that Speaker was infected with the TB strain by someone else. Huitt said Speaker had traveled extensively over the last six years to countries where tuberculosis is more common

The centers said that the strain of tuberculosis that Mr. Speaker has does not match any of the strains in its laboratories. And Dr. [Robert C. Cooksey] said, ''My son-in-law's TB did not originate from myself or the C.D.C.'s labs, which operate under the highest levels of biosecurity.'' Also, Italian officials said that they did not learn about the case until Mr. Speaker had left Italy. Cesare Fasari, a spokesman for Italy's Health Ministry, said that had the Italian health officials been notified in time, they would have ''intercepted the man and invited him to be treated in a hospital'' with his permission. Mr. [Jason Vik] spoke angrily about Mr. Speaker's behavior. ''He stepped on a plane with 487 people, one of the largest aircraft that Boeing makes, and he put us all at risk, just so he could go get married,'' he said

The man, who declined to be identified in the newspaper article because of the stigma attached to his diagnosis, said he and his wife had decided to sneak back into the United States via Canada rather than have him be treated in isolation in Italy. 'I'm a very well-educated, successful, intelligent person,' he told the paper. 'This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary- confinement-in-Italy thing.' That appraisal was based on tests showing that the number of tuberculosis bacteria in the man's sputum were too low to be detected but still enough to infect others. [Julie Gerberding] said her agency was erring on the side of caution because the form of tuberculosis, known as XDR TB, is often fatal and is a growing public health threat in many countries. The advisory applies only to crew members on the man's flight and to his fellow passengers, particularly those who were seated next to him and in the two rows behind him and the two rows in front of him. 'We're not concerned about a generic threat to travelers,' Gerberding said

The efforts ''weren't fast enough,'' Dr. [Martin S. Cetron] said, adding that ''we certainly will be learning lessons and looking to improve'' current systems. ''It's irresponsible in active tuberculosis for anyone to be on an airplane -- whether it's multi-resistant or not,'' said Dr. [Richard P. Wenzel], an infectious disease expert at Virginia Commonwealth University in Richmond. At a time when airline passengers have to discard shampoo bottles in the airport security line, Dr. Wenzel said, ''We don't have a simple sort of wand at the airport to wave to say, 'You have tuberculosis.' It really counts on the responsibility of the individual.''

That appraisal was based on tests showing that the number of tuberculosis bacteria in the man's sputum were too low to be detected but still enough to infect others. Dr. [Julie L. Gerberding] said her agency was erring on the side of caution because the form of tuberculosis, known as XDR TB, was often fatal and a growing public health threat in many countries. ''We're not concerned about a generic threat to travelers,'' Dr. Gerberding said. Dr. Gerberding said doctors had not determined the source of the man's infection. Molecular fingerprints used to distinguish among bacterial strains so far do not match that of any other known case, she said. People who think they may have been exposed to TB or XDR TB can call (800) CDC-INFO for more information

Epidemiologists from the Centers for Disease Control and Prevention have linked the acanthamoeba keratitis outbreak to AMO Complete Moisture Plus Multi-Purpose Solution. Advanced Medical Optics of Santa Ana, Calif., manufactures the solution, which is used to clean and store soft contact lenses